Advocacy Briefs

Oregon State Legislature to Allow Pharmacists to Prescribe PrEP and PEP drugs

Along the lines of expanding access to (and better utilization of) routine care and prevention services, the Oregon State Legislature is poised to pass a bill that allows registered pharmacists to prescribe HIV pre-and post-exposure prophylaxis (PrEP and PEP) drugs. 

State representatives of the Oregon House voted overwhelmingly 47–7 to pass House Bill 2958.

If the bill passes the Senate and Governor Brown, a Democrat, signs it, Oregon would be only the third state with legislation like this on the books—California and Colorado being the other two. 

Cascade AIDS Project (CAP), a nonprofit HIV organization that provides a wide range of health services for people living in Oregon and Southwest Washington, is leading the effort to pass the bill.

“We have had PrEP, this incredibly powerful HIV prevention tool, for almost a decade, but it’s just not getting into the hands of those who need it most,” said Jonathan Frochtzwajg, Public Policy & Grants Manager, for CAP. “For example, fewer than 1%mof patients prescribed PrEP are Black, even though Black people account for 42% of people newly diagnosed with HIV. Our traditional pathways for accessing medication are not working for marginalized communities. We need to disrupt those pathways. Pharmacist prescription of PrEP is one way of doing that, so we in Oregon are excited to join California and Colorado in adopting this policy.”

PrEP, which is currently available as a branded tablet (either Truvada or Descovy), is manufactured by Gilead Sciences, but a generic version of Truvada became widely available back in fall 2020. With high adherence, it provides significant levels of protection, blocking infection of HIV by upwards of 99% among men who have sex with men; and upwards of 90% protection among heterosexual men and women. PEP, too, is equally as effective when taken within 72 hours of exposure.

Authorizing pharmacists to prescribe both PrEP and PEP would offer at-risk communities across Oregon’s rural and minority communities—most notably Black Americans and Latinos—expanded access, which could be a dynamic shift in the state’s prevention landscape, getting the state closer to zero new infections by 2030. 

The legislation is also notable because it codifies the state’s pharmacists’ legal authority to conduct HIV tests—the first step before any HIV prevention regimen.

The bill itself is timely because while the US Preventive Services Task Force (USPSTF)— an independent body that makes recommendations about the effectiveness of specific preventive services for patients—gave PrEP a grade “A” rating back in June 2019. That’s significant because the Patient Protection and Affordable Care Act (or the ACA) requires health plans to cover preventative services that receive either an “A” or “B” grade. That requirement only recently kicked in on January 1, 2021. That recommendation has enormous implications for insurers and coverage. Health insurers were given that time to adjust to the new ruling. 

But not all plans are covering what they “ought” to. And ongoing coverage restrictions, such as prior authorizations and drug-tiering, continue to present significant barriers to PrEP patients. These restrictions can either delay or discourage PrEP prescription fills, increasing patient “walk-away” rates.

Equally as crucial to ending the epidemic is it has a significant influence on reducing the incidence of HIV transmission at the community viral load level. That’s so important for people who live in high-prevalence communities. But to date, the CDC estimated that only 1 in 5 people who are recommended or indicated as being clinically at-risk are actually receiving PrEP.

In summary, the bill prohibits specified health insurers from requiring prior authorization during the first 60 days of treatment for medication therapy prescribed for opiate withdrawal or antiretroviral drugs. Exempts health maintenance organizations from prior authorization prohibition. In addition, the text of House Bill 2958 requires health insurance policies that have a prescription drug benefit to “cover the cost of the drug prescribed and dispensed by pharmacists within their scope of practice, including the cost of pharmacists’ consultation fees associated with prescribing and dispensing drugs.

By: Scott Bertani, Director of Advocacy

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